Provider Demographics
NPI:1740731587
Name:BERGAN, ZACHARY (RPH)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:BERGAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 ARVILLE ST STE 156
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4937
Mailing Address - Country:US
Mailing Address - Phone:702-815-0800
Mailing Address - Fax:702-815-0801
Practice Address - Street 1:5275 ARVILLE ST STE 156
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4937
Practice Address - Country:US
Practice Address - Phone:702-815-0800
Practice Address - Fax:702-815-0801
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist